Fetal surgery: Improving life trajectories before birth

Fetal surgeon Dr. Aimen Shaaban and pediatric surgeon Dr. Erin Rowell review a fetal ultrasound. 

It all starts with an ultrasound – a standard procedure near the mid-point of pregnancy. For the vast majority of parents, it is a confirmation that their baby is growing as expected. But for some, the excitement surrounding the arrival of their child is shattered when a severe birth defect is discovered.

Decades ago, physicians could only offer a handful of treatments for babies with spinal, heart or other serious anatomical problems. Sometimes there were no options at all. Today, science has moved from treating these conditions after birth to treating them during fetal development.

Advances in imaging technology and prenatal testing allow clinicians to detect and track the progression of abnormalities much earlier in a woman's pregnancy. And revolutionary work in fetal surgery has led to procedures that correct these issues while the baby is still in the womb.

The Chicago Institute for Fetal Health at Lurie Children's has provided a wide range of care and services for pregnant mothers with complex fetal diagnoses for 40 years. The institute is the regional leader, and is one of only a small number of comprehensive fetal care centers in the country.

The fetal health program took a quantum leap forward in July with the addition of fetal surgeon Aimen Shaaban, MD, who also serves as the Director of the institute and is a national leader in the field. He is one of fewer than two dozen surgeons worldwide with the expertise to perform in utero surgery to correct congenital defects before birth. Lurie Children's is the only pediatric facility in the Chicago area with a dedicated fetal surgeon trained in a broad spectrum of fetal interventions.

"We have an established center that has the advanced imaging technology needed to make a diagnosis and provide education, delivery planning, care coordination and early intervention for expectant mothers with a complex fetal diagnosis," says Dr. Shaaban. "Now we're building upon this strong foundation to position Lurie Children's as a national leader in fetal medicine."

He leads a multidisciplinary team that includes specialists in general pediatric surgery, maternal fetal medicine​, neonatology, cardiology, cardiovascular-thoracic surgery, neurosurgery, urology, genetics, medical ethics and nursing. They work closely together to develop a personalized care plan for mothers with complicated pregnancies. The team offers a full spectrum of prenatal interventions, including prenatal surgery for spina bifida, EXIT procedures for airway obstruction, amniotic band syndrome and treatment for bladder outlet obstructions.

By far, the most common procedure Dr. Shaaban performs is on patients with twin-twin transfusion syndrome. The condition results when identical twins share a single placenta with an imbalance in blood flow. The result is that one twin gets too much blood while the other twin gets too little. About 10 to 15 percent of identical twins develop this condition which, if not treated, usually results in the loss of at least one of the twins.

With a 60-minute laser surgery procedure using a local anesthetic, we can make an impact on multiple lives," says Dr. Shaaban. "One of my favorite things is to get holiday cards from these families showing their healthy twins."

He and other members of the institute are involved in a variety of research projects to push the boundaries of fetal interventions. Dr. Shaaban says that such research has the capacity to move from concept to clinical application faster than in most fields of medicine – sometimes within just a matter of months.

"Fetal medicine is really a study in understanding the origins of disease," says Dr. Shaaban. "By understanding how diseases develop during pregnancy, we can determine if, when and how to intervene to ensure the greatest chance for a healthy baby and a healthy mom."

This article originally appeared in the Spring 2018 issue of Heroes magazine.